Asthma symptoms

Improvements in asthma treatment include the development of more effective, safer formulations of known dmgs. The aerosol adrninistration of P2-agonists or corticosteroids results in a decrease in side effects. Also, the use of reUable sustained release formulations has revolutionized the use of oral xanthines which have a very narrow therapeutic index (see Controlled release technology). For many individuals, asthma symptoms tend to worsen at night and the inhaled bronchodilatots do not usually last through an entire night s sleep (26,27). 

The health effects of non-infectious bioaerosols include allergy symptoms, asthma symptoms, and hypersensitivity pneumonitis. 

The activation of mast cells by allergen initiates the asthma symptoms within minutes after allergen contact, the early allergic response (EAR), within horns the late allergic response (LAR), and within years and after rqDeated asthma episodes, chronic airway inflammation, airway remodeling, and airway hyperresponsiveness. 

There is now good evidence that the clinical manifestations of asthma symptoms - impairment of lung function, sleep disturbances, limitations of daily activity, and the use of rescue medications - can be controlled with appropriate treatment. When asthma is controlled, there should be no more than occasional recurrence of symptoms and severe exacerbations should be rare. 

Salmeterol is a long-acting inhaled bronchodilator and is not used to treat acute asthma symptoms. It does not replace the fast-acting inhalers for sudden symptoms. Salmeterol should not be used more frequently than twice daily (morning and evening). 

Inform the primary health care provider if asthma symptoms do not improve within 4 weeks of initiating treatment. The primary health care provider may discontinue the drug therapy. 

Classify asthma severity based on asthma symptoms. 

Up to 80% of asthmatics have symptoms of rhinitis, and inflammation of the upper airways may increase AHR.1,3 Treatment of rhinitis with intranasal corticosteroids may improve asthma symptoms and is recommended for asthma patients with rhinitis. 

Acute and chronic sinusitis can also aggravate asthma, and antibiotic therapy of sinusitis may improve asthma symptoms.3 Nasal polyps are associated with aspirin-sensitive asthma, and adult patients with nasal polyps should be counseled against using non-steroidal anti-inflammatory medications.1,3... 

Gastroesophageal reflux has been associated with increased asthma symptoms, especially nighttime symptoms. 

Non-selective 3-blockers, including those in ophthalmic preparations, may cause asthma symptoms, and these agents should be avoided in asthmatics unless the benefits of therapy outweigh the risks.1 In asthmatic patients requiring 3-blocker therapy, a Pi-selective agent should be chosen. Because selectivity... 

Assessment of diurnal variation of PEF may be useful in patients who have asthma symptoms and normal spirometry. When spirometry is equivocal, a 20% or greater decrease in FEV after the administration of methacholine is diagnostic for asthma. A negative bronchoprovocation test with methacholine may help rule out asthma. 

There is little evidence for other food allergies as a routine cause of worsening asthma symptoms.1,3... 

Viral infections are the most common cause of increased asthma symptoms and asthma exacerbations. 

Patients sensitive to specific allergens should be educated on ways to avoid them. Environmental controls to reduce the allergen load in the patient s home may reduce asthma symptoms, school absences because of asthma, and unscheduled clinic and emergency visits for asthma.13 Patients allergic to warm-blooded pets should remove them from the home if possible or at least keep them out of the bedroom. However, allergens may remain in the home for months after the pet is removed.1... 

Leukotriene modifiers either inhibit 5-lipoxygenase (zileuton) or competitively antagonize the effects of leukotriene D4 (montelukast and zafirlukast). These agents improve FEV, and decrease asthma symptoms, rescue drug use, and exacerbations due to asthma. Although these agents offer the convenience of oral therapy for asthma, they are significantly less effective than low doses of inhaled corticosteroids.2,33... 

In patients with mild intermittent asthma, long-term control medications are not necessary, and patients should use a short-acting inhaled P2-agonist t° prevent or treat symptoms.2 This classification includes patients with exercise-induced asthma, seasonal asthma, or asthma symptoms associated with infrequent trigger exposure. Patients can pre-treat with two puffs of cromolyn or nedocromil prior to exposure to a known trigger. The treatment of choice for exercise-induced asthma is two inhalations of albuterol 5 minutes prior to exercise.1 Cromolyn and nedocromil are less effective than albuterol for prophylaxis of exercise-induced asthma. 

Exercise is one of the most common precipitants of asthma symptoms, and exercise-induced asthma is commonly seen in children and adolescents. Exercise may be a precipitant in up to 90% of the population with asthma and maybe the first precipitant noticed in an asthma patient.18 Shortness of breath, wheezing, or chest tightness usually occur during or shortly after vigorous exercise and resolve within 30 to 60 minutes. 

Monitor symptoms such as wheezing, shortness of breath, chest tightness, cough, and nocturnal awakenings due to asthma symptoms. Daytime symptoms should occur no... 

The severity is determined by lung function, symptoms, nighttime awakenings, and interference with normal activity prior to therapy. Patients can present with mild intermittent symptoms that require no medications or only occasional use of short-acting inhaled /f2-agonists to severe chronic asthma symptoms despite receiving multiple medications. 

Clinicians agree that diagnosis of OA requires demonstration of a direct causal relationship between the onset of asthma symptoms with the work environment and not to elements encountered outside the workplace. 

SIC are not performed all the time as some clinicians don t have access to these specialized centers or none are available. For some sensitizers, a challenge test is not needed since other information is available and sufficient to prove OA. For example, if an allergen has been identified in the workplace and the worker is sensitized to the allergen and has asthma symptoms at work that resolve or improve away from work then the causal relationship can be ascertained and diagnosis of OA be reported. 

Gautrin, D., Ghezzo, H., and Malo, J.L., Rhinoconjunctivitis, bronchial responsiveness, and atopy as determinants for incident non-work-related asthma symptoms in apprentices exposed to high-molecular-weight allergens, Allergy, 58, 608, 2003. 

I ve been chemically sensitive for a long time, but I did not know what that was. I always knew that when new carpet went into a home or a store, I couldn t go there. I knew I could not tolerate anyone s perfume or to wear it myself. Mold would elicit asthma symptoms. I could not stand the fumes from the chemicals used by exterminators in the school where I worked. I knew that I was very sensitive to certain medications. 

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